• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.68-74
• /
• 2010

Purpose: The purpose of this study is, first, to analyze the risk factors that influence the severity of injury in pediatric multiple trauma patients and, second, to present solutions for the problems related to the treatment of such patients. Our living situations are so complicated that the danger of accidents is truly open to children who are not prepared. We need to draw attention to the increased numbers of various accidents involving children. Methods: We studied patients who visited the Emergency Medical Center at Chosun University Hospital from January 1, 2006, to December 31, 2008. Using medical records, we evaluated the general characteristics: the mechanism of injury, the vital signs, the revised trauma score (RTS), the injury severity score (ISS), and the hemoglibin value, which was checked at the time of visit, and the presence or the absence of emergent on regular surgery. We divided the level of injury as follows: light level (1-8 points), mid level (9-15 points), and serious level (above 16 points). We analyzed the medical data by using SPSS 17.0 for windows. Results: The average age of the patients examined was 8.6 years. The number of 6- to 11-year-old patients was 96, which was the largest, but the degree of injury severity was the highest among infant (0-2 years), according to ISS 7.95(${\pm}6.85$). The frequency of accidents was highest on sunny days, and most accidents occurred from 16:00 to 20:00. The cause of multiple trauma for children was the greatest in the traffic accident, (95 patients, 49.0%). In addition, the trauma caused by traffic accidents showed the highest ISS value ($9.02{\pm}6.42$) and the most serious degree (P=0.004). The ISS level of injury ($8.40{\pm}6.64$) for patients moved from a secondary hospital was higher than that ($6.49{\pm}5.57$) for patients who visited the medical center directly. The severity of injury was highest for patients who used a 119 ambulance ($8.84{\pm}5.80$). According to the injured parts of body, Injuries to the arms and the feet most frequent (79 patients, 40.7%), but the level of injury was the highest for internal organs and chest, $16.42{\pm}8.56$ and $11.23{\pm}6.97$, respectively. Conclusion: We used Abbreviated Injury Scale (AIS) in order to examine the characteristics by injured body part for pediatric multiple trauma patients. Because the degree of injury was the highest for internal organs or the chest, we need to more seriously examine and provide for patients who are suspected of having injuries to the internal organs or the chest. We need to quickly determine the need for surgery in patients with serious injuries to the arms and the feet, which is the greatest in frequency. In particular, we need to consider the surgical care of patients who are not very high in the severity of injury to their brains.

• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.128-133
• /
• 2010

Purpose: All-terrain vehicle (ATV)-related injuries have increased since the introduction of ATVs to Korea. The purpose of this study is to compare patients with ATV-related injuries (PATV) to patients with motorcycle (MC)-related injuries (PMC). Methods: We retrospectively analyzed the clinical records of PATV and PMC who visited an emergency center in 2008. The cases of PMC were 164, and those of PATV were 52. Results: While PMC are seen evenly in the first half year and the second half year, PATV are seen mainly the first half year (from March to June: 73%). For PMC the most frequent injury mechanism was collision with another vehicle, while for PATV, it was side overturn/roll over. The injury severity score (ISS), the revised trauma score (RTS), the trauma score and the injury severity score (TRISS) were $5.6{\pm}5.6$, $7.7{\pm}0.7$, $5.0{\pm}2.1$ for PMC and $7.1{\pm}7.5$, $7.7{\pm}1.1$, $5.5{\pm}1.5$ for PATV, respectively. The most common injury sites were the lower extremities for PMC and the face for PATV. The rates of admission, surgery and the length of hospital stay were similar between PMC and PATV. Conclusion: This study shows that the risk of ATV accidents is similar to that of MC accidents. We recommend that the same safety standards and regulations that are applied to MCs should be used for ATVs. Safe and enjoyable paths have to be sought for drivers of ATVs.

• Journal of Chest Surgery
• /
• 제43권3호
• /
• pp.285-291
• /
• 2010

배경: 흉부외상은 개발도상국인 나라에서 이환율과 사망률의 가장 많은 원인 중에 하나이다. 흉부둔상으로 발생하는 늑골골절은 외상의 중증도를 나타내는 중요한 지표이다. 연구의 목적은 늑골 골절을 치료시 이환율과 사망률을 확인 하고자 하였다. 대상 및 방법: 2002년 5월부터 2008년 12월까지 입원 후 3일 이내 타 병원으로 전원을 간 환자를 제외한 둔상으로 인한 늑골골절이 발생한 환자를 대상으로 후향적으로 연구하였다. 이 기간 동안 474명이 입원하였고, 454명이 연구에 포함되었다. 남자가 356명 여자가 9명이었고 평균나이는 53세(5~90세)였다. 결과를 예측하는 요소로 손상기전, 늑골 골절수, 중환자실 입원기간 그리고 ISS, 입원기간, 폐 합병증과 사망률을 조사 하였다. 결과: 외상의 기전으로 교통사고 189명(41.7%), 보행 중 넘어짐 103명(22.7%), 추락 85명(18.7%) 그리고 농기계 사고 30명(6.6%), 산업재해 32명(7.0%), 폭행 15명(3.3%)였다. 흉부내 손상으로 혈흉 269명(59.3%), 기흉 144명(31.7%) 폐좌상 95명(20.9%) 그리고 피하기종 29명(6.4%), 큰 혈관손상 5명(0.1%)이 있었다. 대부분의 환자는 보존적인 치료를 하였고, 흉관 삽관술 시행은 234명(51.5%)이었으며, 개흉술은 18명(4.0%)이었다. 평균 흉관삽관 기간은 $5.2{\pm}6.2$일이었다. 대부분의 환자는 일반 병동에서 치료를 하였으며, 평균 입원기간은 $22.5{\pm}20$일이었다. 평균 ISS 수치는 $14.8{\pm}10.9$ (3~75)였고 사망률은 4.9% (22명)였다. 입원기간에 영향을 주는 것은 늑골골절 수, 흉관삽관 기간, 폐질환 동반 그리고 산재보험 이었고, 사망에 영향을 미치는 요인으로는 폐좌상, ISS가 예후에 영향을 주는 주요한 요인이었다. 결론: 늑골 골절은 중증손상을 나타내는 지표이다. 합병증과 동반된 손상 때문에 늑골골절 환자들은 입원하여 치료하는 것이 좋다고 생각한다. 최근의 연구에서 40대 이하의 젊은 환자도 노년층의 환자와 같이 늑골골절로 인한 이환율과 사망률이 증가 한다고 한다. 우리의 연구에서는 ISS와 페좌상이 사망률에 영향을 주고 있다. 늑골골절이 1개 또는 이상인 늑골 골절만 있는 환자도 입원치료를 하는 것이 좋을 것으로 생각 한다.

• Journal of Trauma and Injury
• /
• 제28권3호
• /
• pp.177-181
• /
• 2015

Purpose: Assessment of the trauma severity associated with the prognosis of trauma patients. But we are having a lot of difficulties in assess the severity because of scarcity of current first-aid records resources. Methods: We presumed that Applying the Revised trauma score which consist of vital signs and GCS score will be helpful to assess the sevirity.This study covers the 10069 patient of Ewah womans hospital (2011.1.1.-2014.12.31) who are able to verify the GCS score from fist-aid records. Results: There is no distinctions between prehospital RTS and hospital RTS. And shows high level of correlation between prehospital RTS and ISS. Conclusion: Therefore we conclude that checking the GCS and RTS at prehospital state will be help to assess the severity of trauma patients.

• Journal of Trauma and Injury
• /
• 제26권3호
• /
• pp.89-98
• /
• 2013

Purpose: The assessment of trauma patients in the prehospital setting is difficult, but appropriate field triage is critical to the prognosis of trauma patients. We sought to evaluate the triage given by the emergency medical technicians (EMTs) using the trauma score to patients injured in motor vehicle collisions (MVCs). Methods: From June 2012 to July 2012, questionnaires were distributed to EMTs, who had transported injured patients to the study hospital. Scene records, photos of the damaged vehicle, and ambulance run sheets were used to provide physiologic, physical, and mechanistic information about the MVC. To evaluate the appropriateness of the injury assessment by EMTs, we compared their impressions with the hospital's final diagnosis within a 3 level triage system comprising both the maximum abbreviated injury scale (MAIS) and the injury severity score (ISS). Kappa (k) was calculated to evaluate the agreement between the triage by EMTs and the triage based on hospital's final diagnosis. Results: A total of 91 patients were analyzed by 31 EMTs. The percentage of males was 57.1%, the mean age was 44.5, and the mean MAIS and ISS were 2.7 and 16.6 respectively. While EMTs correctly diagnosed patient injuries to the extremities in 35.7%, and to the neck in 32.1%, pelvic injuries were missed in 80.0%. The agreement between the triage by the EMTs and the triage based on the hospital's final diagnosis was 62.6%(k=0.366) by the MAIS and 50.5%(k=0.234) by the ISS. The kappa value was higher in EMT-I than in EMT-II. Conclusion: In MVC, the assessment of injured patients by EMT-I was more appropriate, and the 3-level triage method based on the MAIS could contribute to a more accurate triage. Prospective studies to search for appropriate methods of field triage are required for programming practical education for EMTs.

• Journal of Trauma and Injury
• /
• 제19권2호
• /
• pp.159-163
• /
• 2006

Purpose: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. Methods: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS${\leq}15$, and mCTAS${\geq}3$. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. Results: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS${\leq}15$ group 30 cases (62.5%) and mCTAS${\geq}3$ group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). Conclusion: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.

• Journal of Trauma and Injury
• /
• 제27권4호
• /
• pp.170-177
• /
• 2014

Purpose: The first regional trauma center selected in Korea was the Gachon University Gil hospital regional trauma center; expectation on its role has been high because of its location in the Seoul metropolitan region. To determine if those expectations are being met, we analyzed the patients visiting the center and their treatment experiences for the past 3 years in order to propose a standard for the operation of a trauma center. Methods: The visiting route, visiting methods, performance of emergency surgery, the ward and the length of stay, the injury mechanism, the injury severity score (ISS), the department that managed the surgery, and the cause of death were analyzed for 367 patients visiting the center from its establishment in June 2011 through December 2013. Results: The mean age of the patients was 47 years (285 male and 82 female patients). A total of 187 patients directly visited the center whereas 180 were transferred to the center. Traffic accidents comprised the majority of injury mechanisms, and 178 patients underwent emergency surgery. The mean length of stay per patient was 11 days for those in the ICU and 27 days for those in a general ward. These patients occupied 4 beds in the ICU and 10 beds in the general ward per day. A total of 1.21 surgeries were performed per patient, and the mean number of surgeries performed per day was 0.49. The mean ISS was 15.91, and 183 patients (50%) had an ISS of ${\geq}16$. Thirty-one patients died; they had a mean ISS of 28.42. The most frequent cause of death was multi-organ failure. The mean number of treatment consultations during a patient's stay was 6.32. Forty-five patients (13%) were discharged from the center, and 291 (79%) were transferred to another hospital. Conclusion: A systematic approach to establishing a treatment model for trauma patients, including injury mechanism, multidisciplinary treatment, and trauma surgeon intervention, is required for treating trauma patients.

• 한국산학기술학회논문지
• /
• 제17권5호
• /
• pp.530-537
• /
• 2016

본 연구는 정면충돌사고를 분석하여 충돌방향과 관련된 운전저의 행동변화를 분석하고, 인체손상정도를 파악해보고자 한다. 연구기간은 2013년 8월~2014년 1월까지로 응급의학 팀에 의해 차량의 손상정도와 인체상해 데이터를 수집하였다. 자료수집에서 사고차량, 사고방향 등은 KIDAS(Korea In-depth Accident Study; 한국형 교통사고 심층조사)와 인체손상정보에 기반을 둔 ISS(Injury Severity Score; 인체손상점수) 내용을 수집하였다. 자료분석은 Minitab 17과 SPSS 22.0을 이용하여 빈도분석과 ANOVA분석을 시행하였다. 분석결과 정면충돌은 12시 방향에서 55.8%로 가장 높게 나타났다. 연령에 따른 정면충돌 방향을 분석해 본 결과 11시방향이 평균 $46.46{\pm}13.47$세, 12시방향이 $44.43{\pm}13.40$세, 1시 방향에서 $52.46{\pm}12.04$세로 통계적으로 유의하게 연령이 높을수록 1시 방향에서 높게 나타났다(p<0.05). 남자의 연령에 따른 정면충돌 방향에서도 11시방향이 $47.10{\pm}13.88$세, 12시방향이 $45.24{\pm}13.78$세, 1시 방향에서 $55.73{\pm}13.38$세로 연령이 증가함에 따라 1시방향의 충돌이 높게 나타났다(p<0.05). 그러나 여자의 경우 연령에 따른 정면충돌 방향에서는 통계적으로 유의하지 않았다(p>0.05). 남녀의 연령에 따른 충돌방향에서의 ISS점수를 비교해봤을 때 남자의 경우 $ISS{\geq}9$에서 12시방향 충돌은 감소하고 ISS<9에서 1시방향 충돌이 증가하였다(p<0.05). 결과적으로 정면충돌방향은 12시 방향에서 가장 높은 빈도로 일어나고, 연령이 증가할수록 정면충돌 방향이 1시 방향으로 높아져 ISS점수가 낮아진다. 따라서 남성에서 12시방향 충돌을 인지하고 핸들을 왼쪽으로 틀어 1시 방향 충돌로 바꾸어 신체손상을 줄이려는 행동을 한다.

• Journal of Trauma and Injury
• /
• 제26권3호
• /
• pp.99-103
• /
• 2013

Purpose: This hospital has operated a trauma system of the inclusive trauma system under the sponsorship of this hospital and with financial support from the government from 2011, and it has been designated as a specialized trauma center (candidate) since November 2008. Therefore, this emergency medical center evaluated the influence of the inclusive trauma system on the course of healing and on the results for trauma patients within the region. Methods: The medical records of all patients who were registered as trauma patients from among those who visited the emergency medical center of this hospital from April 2009 to May 2012 were retrospectively reviewed. The monthly and the annual averages of important indices, such as the time in the emergency room and preventable mortalities, were calculated, and patterns of change were sought. The preventable mortality rate was calculated by using the Trauma Injury Severity Score (TRISS) for each patient. Results: The total number of patients registered from April 2009 to May 2012 was 601, and male patients accounted for a larger proportion(432 males(71.88%) vs. 169 females(28.12%)). Their average age was 46.2 years, the average Revised Trauma Score (RTS) was 5.74 points, and the average Injury Severity Score (ISS) was 26.99 points. The preventable mortality rate during the entire period, which was calculated using the TRISS, appeared lower than the preventable mortality rates reported in past studies in the Republic of Korea. Conclusion: These results for the operation of a new trauma system are limited in that they are only for a local private university hospital. However, results show greater changes and developments in and out of the hospital due to multilateral endeavors by the trauma team and the hospital. These endeavors include increased communications among the departments and development of a complementary patient registration system.

• Journal of Trauma and Injury
• /
• 제27권4호
• /
• pp.101-107
• /
• 2014

Purpose: Recently, the population of elderly people has been increasing rapidly all over the world. The social activities of the aging population have increased, which has also increased the number of elderly patients injured in traffic accidents. Thus, we analyzed the characteristics of elderly patients involved in traffic accidents. Methods: This study was conducted retrospectively from July 2008 to March 2009 among trauma patients involved in traffic accidents who visited Wonju Severance Christian Hospital. Patients under 18 years of age and pregnant patients were excluded. We divided the patients in two groups, a geriatrics group and an adult group on the basis of an age of 65. We compared the types of traffic accidents, the locations of the accidents, the behaviors of the patients at the times of the accidents, the use of seat-belts, and alcohol consumption between the two groups. We calculated the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) for each group. Results: Total number of the included patients was 903, and the number of elderly patients was 181 (mean age: $71.7{\pm}4.9$ years old). There were no significant differences in the initial vital signs, GCS (Glasgow Coma Scale), and RTS between the two groups. There were differences in the types and the locations of the crashes, the behaviors of the patients at the times of the accidents, the use of seat belts, and alcohol consumption between the two groups (p<0.05). The average ISS of the geriatric group was higher than that of the adult group ($9.66{\pm}10.11$ vs. $6.59{\pm}8.99$, p=0.004). The mortality was higher in the geriatric group (n=17,9%) than in the adult group (n=23,2%) (p=0.004). Conclusion: The numbers of mortalities and surgical procedures were greater within the elderly group than the adult group. The average ISS was higher in the geriatric group than in the adult group. The severity of injuries due to traffic accidents was higher in the geriatric group than it was in the adult group.